Cardiovascular risk screening of patients with serious mental illness or using antipsychotics in family practice.

Background Patients with a serious mental illness (SMI) and those using antipsychotics (AP) have an elevated risk for cardiovascular disease (CVD). In the Netherlands, the mental healthcare for these patients is increasingly provided by family practitioners (FPs), following a shift from secondary to primary care. It is therefore essential to better understand the characteristics of this patient group and the (somatic) care provided by their FPs. The aim of this study was to examine the rate of cardiovascular risk (CVR) screening in patients with SMI or those using APs in family practice. Methods We performed a retrospective cohort study of 151,238 patients registered with 24 family practices in the Netherlands. From electronic medical records, we extracted data concerning diagnoses, the measurement of CVR factors, medication, and the frequency of visits over a two-year year period. The primary outcome was the proportion of patients who were screened for CVR factors. We compared three groups: patients with SMI or using AP without diabetes or CVD (SMI/AP only), patients with SMI or using AP and diabetes mellitus (SMI/AP+DM), and patients with SMI or using AP and a history of CVD (SMI/AP+CVD). We explored the factors associated with adequate screening using a multilevel logistic regression. Results We identified 1705 patients with SMI or using AP, 834 of whom had a SMI diagnosis and 1150 of whom used AP. CVR was adequately screened in 8.5% of the SMI/AP-only group (117 of 1383 patients). Screening was much more commonly performed in the SMI/AP+DM (n=206, 68.4% adequate) and SMI/AP+CVD (n=116, 26.7% adequate) groups. (ORs for moderate and adequate screening 21.8 (95%CI, 15.4-30.8) and 4.3 (95%CI, 2.8-6.6) respectively). A high frequency of FP visits, age, the use of AP, and a diagnosis of chronic obstructive pulmonary disease were associated with a higher screening rate. In addition, we examined the differences between patients with SMI and patients using AP in the absence of a SMI. ConclusionsCVR screening in patients with SMI or using AP is often inadequate or lacking in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as a comorbidity.